Otomycosis is a common disease in North Iraq. Of the 219 cases diagnosed clinically in Mosul Teaching Hospital seen during a 15 month period, 179 were due to fungus infection. The disease was more frequently encountered in young adults whose age was range from 16–30 years. The incidence of the disease was significantly higher in females (65.4 per cent), mainly housewives, than in males. Aspergillus species were the dominant isolated fungi (92.1 per cent).

The results of a first series of fifty stapedectomies, using newly adopted ‘Fisch stapedotomy technique’ are presented and contrasted with ‘world results’ and results of leading otologists.

The essential points in the evolution of stapes surgery are outlined.

In the light of the small number of deaf otosclerotics the philosophy of who should be performing stapes surgery and who should be trained to perform it, is discussed.

The title ‘Collective Stapedectomy’ denotes personal system of collecting patients from the waiting list in batches and operating on each stapedectomy batch in consecutive fashion.

Despite the complex embryological development of the nose and surrounding structures, significant developmental nasal anomalies are rare. We therefore present our experience in the management of such anomalies (excluding choanal atresia) over the past 10 years.

Fifty cases were surgically treated; two nasopharyngeal cysts, four hairy polyps, two meningoencephalo coeles, seven gliomata, 20 dermoids, two capillary haemangiomata, four fibromas, one fibromyxyoma, one mucocoele, one granuloma, one lipoma, two nasal aplasias, two nasal clefts and one nasal web. All cases presented with nasal obstruction and/or as a nasal mass. Computerized tomography and magnetic reson ance imaging aided diagnosis determining the extent of intracranial involvement. Various surgical tech niques were used ranging from simple excision to the lateral rhinotomy and Goodman's external rhinoplasty approach. Only five patients (10 per cent) suffered complications; two CSF leaks and three recurrences, all treated successfully.

Correction of a saddle nose deformity due to atrophic rhinitis is a formidable task. The thick and puckered skin secondary to long standing disease makes the creation of a dorsal subdermal pocket difficult. On the one hand, these patients tolerate synthetic implants poorly and on the other they show an unusually high rate of absorption of autologous bone graft. Our experience of treating 15 patients with saddle nose defor mity secondary to atrophic rhinitis is presented.

Submucosal diathermy (SMD) is a common surgical procedure carried out to improve the nasal airway. A case is presented in which it was followed by profuse epistaxis which required transfusion of 28 units of blood, eight units of fresh frozen plasma (FFP) and four units of platelets within 14 days.

Fifteen acinic cell carcinomas from an equal number of patients were analysed for their DNA content and proliferative (S-phase) index by flow cytometry from archival tissues. Seven of the carcinomas manifested a diploid DNA content. None of the patients with diploid acinic cell carcinomas died of their carcinomas and none developed metastases in follow-up periods extending for 10 or more years. Four of eight patients with aneuploid acinic cell carcinomas have died because of their malignancies within a 10 year period after the first surgical removal of the carcinoma. Five of the eight patients exhibited metastases. Although the number of cases does not permit strong correlations between histopathological features, abnormalities in DNA content and outcome of patients, it was noted that carcinomas with prominent necrosis, tubulo ductal differentiation and ‘dedifferentiated’ areas displayed more aggressive biological courses.

An audit was carried out to assess the acceptability of long distance travel for elective tonsillectomy and adenoidectomy. Seventy nine children travelled 70 miles with their father or mother to P. A. H. from Mid Glamorgan where the E.N.T. waiting list delay for tonsillectomy was some two years.

Most of the families who were offered the travel arrangements agreed and from the results of the questionnaires answered by the first 50 families, it was shown to be a successful exercise as both the children and parents were very happy with the arrangements and there were no complications.

A previously unreported association between aniridia and congenital sensorineural deafness is reported in a family in which the father and one child possess the combination of abnormalities. One of the remaining two children also has a congenital sensorineural hearing loss without any occular abnormalities.

Pulsatile tinnitus resulting from an abnormal communication between the occipital artery and the transverse or lateral sinus is a rare clinical entity. We report three cases which presented over a period of three years who had such abnormalities demonstrated angiographically and were cured of their symptoms by exploration and ligation of the occipital artery.

We report a case of osteoradionecrosis of the temporal bone which presented with symptoms and signs of cerebellopontine angle lesion. The clinical, radiological, histological and bacteriological findings are reported. The occurrence of osteoradionecrosis of the temporal bone and the factors which predispose to it are discussed with particular emphasis on the time lapse between radiotherapy and its development. This presentation has not previously been reported.

Intranasal adhesions are a common complication following nasal surgery. They may be prevented by the use of silastic splints, which are also a very effective treatment for established lesions. We report a patient where intranasal adhesions rapidly recurred despite the use of splints, who was found to be suffering from Wegener's granulomatosis.

The old Indian literature describes a technique known as Sutra-Neti. That is, passing a catheter or similar material through the nose and out of the mouth as a means of clearing the airway. One of our patients adapted this method, tying the catheter end to end, in order to control his severe snoring and obstructive sleep apnoea. This was effective for several months. He subsequently responded well to a uvulopalatopharyngoplasty.

A case of atypical supraglottitis in an 11-year-old boy is presented. The epiglottis was only mildly inflamed. The organism isolated from blood culture was Streptococcus sanguis. This organism is a normal commensal of the oral cavity and has not previously been reported as a cause of supraglottitis.

A case of inverted papilloma of the hypopharynx is described. Review of the literature failed to reveal any previous case reports of inverted papilloma of the hypopharynx.

A case describing the use of a metal detector to locate a metallic foreign body swallowed by a prisoner. Initial work up included plain thoracic X-rays and a gastrografin swallow which were negative. A metal detector was used to confirm the presence of a metal body in the oesophagus which was verified by a barium swallow.

An unusual incident of aspiration of a silver tracheostomy tube obturator is described. Common sense advice to patients performing home tracheostomy care may help avoid similar occurrences in the future.

A Case report of a laryngeal malignant mesenchymoma, a very rare head and neck and even rarer laryngeal leison, is reported.

In this case, an 85-years-old man, who had undergone several panendoscopies and biopsies that were non-diagnostic, subsequently succumbed to pulmonary metastases and died from respiratory failure. At autospy, tumour cells were demonstrated to constiute both bone and straited muscle cell types. As the tumour cells differentiated into two types of specialized cells from one type of embryonal tissue, the diagnosis of maligant mesenchymoma was established.